SCAN is committed to partnering with our physician providers in offering high quality geriatric care to our members. A significant part of that effort is to assist our providers in the provision of accurate coding that will contribute to the quality of care and support the expected revenue from the Medicare program. To this end, we present the following tools and education for all the physicians and groups providing care to our members.

Thursday, January 23, 2014

Confessions of a Vegetarian Coder—or, why I hate M.E.A.T.!!

First-- I hope I’m not offending anyone. The spirit of this post is lighthearted, and
I’m having a little bit of fun. BUT, I’m also serious about proper coding, and
that’s my only intent.Better
documentation and coding helps us all in many ways, and should lead to better
and more efficient medical care for the members of our medical groups and
health plans. It also affects our reimbursement. Done correctly, though—a wealth
of important information is obtained, to help our members to obtain access to
excellent treatment programs, that enhance their lives and living.

So, there is NOTHING official about “MEAT”, it’s just a
handy acronym that someone thought up one day. It’s cute.It sort of addresses what’s
needed for ANY diagnosis, not just risk adjustment or so-called “HCC Coding”
(which also doesn’t exist).By law,
under HIPAA, what is required for any ICD-9 code is defined by what is in the
ICD-9-CM Official Guidelines for Coding and Reporting, found
here , and Coding Clinic (see the 2nd
paragraph of the guidelines).You can’t
replace 107 pages with 4 letters, two of which mean the same thing!

If you look at MEAT for just a minute, you can see it’s not
official, and pretty meaningless:

Monitoring (or Medication)

Evaluation

Assessment; or

Treatment

Evaluation and Assessment mean exactly the same thing!And no “Official Guideline” for anything, much less something that leads
to Federal Government payment, would be complete at 4 letters, 6 if you include
the “or”.

EVERY condition that is submitted as an ICD-9 code has to
meet the Official Guidelines.There’s no
exception because something doesn’t risk adjust.Just writing the word “Stable” does not
magically mean you can code something.Or just because the diagnosis listed under the “Assessment” heading in a
chart note doesn’t mean someone assessed it. What is under that word are conclusions, 90
times out of 100, not an evaluation of the patient or an assessment. If you look at the word “evaluation” in
dictionary.com, it says this:

evaluation

e•val•u•a•tion

[ih-val-yoo-ey-shuhn]

noun

1 an act or instance of evaluating or appraising.

2. (especially in
medicine) a diagnosis or diagnostic study of a physical or mental condition. (emphasis
added)

Here’s where the word “meat” or “substance” comes into play.
There really has to be some substance to an evaluation. Just writing:

Diabetes with neurological manifestations

in a chart note does not mean the doctor evaluated ANYTHING
or can code 250.60

First of all ________manifestations isn’t a diagnosis at
all. By itself, it means nothing.No
matter what someone from somewhere told you, you cannot just write “stable” or
“continue on meds” next to a couple of words and you now have something you can
code. I have seen it fail in CMS RADVs
more than once.And I think that failing something like that is
proper. It never should have been coded in the first place!

On the other hand, if you can see in that chart note that
the physician did a foot exam,and documented the patients symptoms of
burning or tingling in their feet, did a monofilament exam—NOW YOU HAVE SOMETHING!!!!!!!!!

Now he or she can say in the “Assessment” section:

Diabetes with diabetic polyneuropathy.Patient started on Neurontin, 300 mg, TID

TA DA!! We have something that we can code!!!YAY!!!!!!!!!!!!! There is the "meat" that's needed. An evaluation and/or some indication that the condition was either assessed, being treated (actively) or it has an impact on the treatment of other diseases as the ICD-9 requires.

When people talk about “HCC Coding” being somehow different,
there isn’t really a citation they can point to, or an example. On the other hand, CMS DOES have specific
signature requirements for a medical record, but that isn’t a coding issue per
se. It is a Medical Record issue.So,
in my diet, I’m a happy omnivore, savoring a juicy steak when I can.But when it comes to “M.E.A.T.” and coding,
I’m a vegetarian coder all the way.

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